This fact constitutes a major irony, in that Ritz, whose dealings with county government — both inside and outside the tent — go back for decades, may be the single most obstinately independent commissioner on the 13-member board, the most inclined by far to take (or propose) drastic steps and to go it alone, especially in all matters fiscal.
This is not to say that Ritz is not personally agreeable. Indeed, he can be uncommonly so, and his differences with other commissioners have to do almost exclusively with policy issues, not personalities.
Though occasionally he can storm and bluster in the manner of, say, Commissioner Sidney Chism (a Democrat who frequently affects a state of rage over what Chism considers GOP “lockstep”), Republican Ritz’s displeasure is most often demonstrated by a slight metamorphosis of his normally pleasant and accommodating grin into one so sardonic and mocking as to put Lewis Carroll’s Cheshire cat to shame.
With the Med in financial crisis, and with a beleaguered county government (which just upped its own contributions from $27 million to $37 million) getting no or minimal help from equally strapped city and state governments, Ritz has just stepped out of formation and thrown what is either a Hail Mary or a bomb. He has intervened directly with the federal government — filing a “civil rights discrimination complaint” against the state of Tennessee and the federal Department of Health and Human Services itself.
Essentially Ritz, acting as an individual and not on behalf of county government (but addressing his complaint under his official commission letterhead) charges that the Med has been unjustly deprived of its rightful share of federal funding — largely as a result of the creation of TennCare.
In the 16 years since the U.S. government granted Tennessee a waiver to route its Medicaid spending via the new machinery of the state-run TennCare, says Ritz, federal funds — particularly those for uncompensated medical care administered to indigent patients at the Med — have been siphoned off throughout the TennCare network, including a variety of private hospitals.
Says Ritz in the letter of complaint (which is accompanied by a variety of supplementary graphs, tables, and other exhibits): “…Tennessee recently received an annual payment from DHHS of over $200 million for uncompensated care. Of that amount DHHS sent to Tennessee $81 million based on the uncompensated care at the Med alone. However, Tennessee has forwarded to the Med total supplemental care payments of $29 million to $39 million a year.”
And Ritz continues: “Therein lies my Complaint against the state of Tennessee.”
The commissioner buttresses his case by demonstrating — this is a civil rights complaint, after all — that the patient base at the Med consists predominantly of minority patients, chiefly African Americans and Hispanics under the poverty line, and that Med employees are also largely drawn from this population base.
And Ritz dismisses what he says is the argument of Governor Phil Bredesen that amounts in the range of $50 million to $60 million of uncompensated care funds distributed through TennCare constitute “a back door way of helping the Med because of the Med’s paying customers/patients are TennCare enrollees.”
Among other things, says Ritz, noting that the new state budget contains new cuts in TennCare appropriations, prior cutbacks n 2007 “had the impact of increasing uncompensated care at the Med because the Med cannot turn down anybody for inability to pay.”
Further: “An ironic result of the state’s current treatment of the Med’s uncompensated care is that the more uncompensated care the Med has, the more Tennessee has for their TennCare bucket to assist all Tennessee hospitals, most of which are private! Even more ironic is the fact that if the Med has to close the TennCare moneybucket for private hospital care will shrink by $50 to $60 million annually!”
In other words, not only the Med itself, which currently faces a looming financial shortage which could run from a low of $32 million to a high of $100 million, but the TennCare network itself are caught in an inescapable and merciless Catch-22.
It remains to be seen how the federal government itself deals with Ritz’s complaint. The reaction from state government can only be described as stony, even hostile. State Finance Commissioner dispatched an email to Med administrator Gene Holcomb seeming to threaten a hands-off attitude toward the Med’s problems and stating “It [Ritz’s complaint] has changed our ability to negotiate any further agreement for the benefit of the Med. I sincerely hope that other sources become available to assist you.”
Members of the county Task Force on the Med appointed by interim county mayor Joe Ford have expressed concern over the effect of the Ritz complaint but also discontent over Goetz’s reaction. Ritz himself has indicated he will continue to press the matter, come what may.
Meanwhile, one of Ritz’s colleagues, Commissioner George Flinn, has launched his own Med-related initiative with the federal government —- one that, like Flinn himself, is direct, straightforward, and free (too free, some would say) of complicated process. Flinn had already prevailed on commission members to endorse his call for a commission letter to this year’s crop of gubernatorial candidates demanding that they pledge to support a routing of all uncompensated care funds generated by the Med to operations of the Med itself.
Flinn, now a Republican congressional candidate in the 8th District, upped the ante at last week’s public meeting of the commission by announcing his own unilateral mission. He said he had arranged a visit to the “White House” to meet with unspecified staff members there in an effort to solve the imbroglio over distribution of uncompensated care funds.
Not everybody in county government is on board with that mission, either. Although the commission would vote to support Flinn’s effort, at least two members — Democrats Henri Brooks and J.W. Gibson were publicly scornful of it.
Nor is everybody attempting to intercede with the feds coming in through the transom a la Ritz and Flinn. 9th District congressman Steve Cohen notified attendees at an open-to-the-public issues meeting in his office on Thursday that he would be attempting, in budget reconciliation negotiations between House and Senate, to acquire more funding for the Med via “disproportionate share” provisions of the federal Medicaid statute.
Meanwhile, the patient — in this case, the Med — remains badly in need of a transfusion and is still on the critical list.
UPDATE: Deidre Malone declares for County Mayor at Chism picnic.